Health and social care

Major challenges lie ahead for the NHS in Scotland. As I reported last year, there are growing pressures on NHS boards which are struggling to juggle service delivery and progress major reform, at the same time as managing considerable financial challenges.

Nearly 160,000 people work in Scotland’s NHS, which provides vital services for millions of us every year. Their hard work and commitment, sometimes in life-or-death circumstances, is always to be admired. However, the NHS faces challenges if the workforce is to meet the growing demands of our ageing population and adapt to new ways of working.

Building on our recent findings, we’ve begun a new two-part audit to evaluate how the Scottish Government and NHS boards are tackling the issues, through workforce planning and national and local initiatives. The first report focuses on overall workforce planning and workforce pressures in hospitals and will be published in summer 2017. The second is due out in 2018/19 and will explore primary care and GP workforce issues.

In advance of our first report, this briefing provides some key information on the shape of the current NHS workforce and sets out some of the issues that we’re delving into during the course of our audit.

About the author

Caroline Gardner is the Auditor General, and Accountable Officer for Audit Scotland. She started her term in July 2012, and has 30 years’ experience in audit, governance and financial management. Follow her on twitter @AuditorGenScot

Over the summer, Audit Scotland ran a survey to try to capture the views of parents and carers about their experiences of early learning and childcare in Scotland. This was a key part of our preparations for a new audit of these services, to give an independent assessment of how the system is working and what outcomes are being delivered for people who access this support.

It was the first time that Audit Scotland had directly reached out families who use these services, so we weren’t sure what kind of response to expect. We were really pleased with the result, as dozens of individuals and organisations helped to spread the word about the survey and over 300 people completed the questionnaire.

We learned a lot from the engagement, and collected some really useful material, including individual stories. Our early analysis of the responses shows a range of recurring views, including the positive impact that early learning and childcare can have on a child’s development and wellbeing.

However, concerns were raised on issues such as the cost of services, a lack of choice, and limited flexibility, particularly for working or studying parents.

It’s important to highlight that reform of early learning and childcare is continuing: in her September announcement on the 2016/17 Programme for Government, the First Minister set out a commitment to double the amount of free care available to all three and four-year-olds, and two-year-olds who will benefit most, by the end of the Scottish Parliament’s fifth session.

This means that our audit will be a timely and relevant contribution to the future development of early learning and childcare services. The views contributed by parents and carers have helped us to lay the groundwork for our audit and shape what questions we want to answer. There are a number of insights that we’ll investigate further and test out during the course of our fieldwork. We’ve set out more detail about our work – which we’ll carry out on behalf of the Auditor General and the Accounts Commission – in a new flyer.

One thing that’s certain is that we want to continue engaging with parents and carers, and we’re looking forward to building on the great response we’ve had so far.

We’ll continue to post updates about when we’ll publish our audit report as our work develops in the coming year – watch this space for news.

About the author

Rebecca Smallwood is an auditor and joined Audit Scotland in 2008. She has worked on a number of audits with a health and social care focus, including community health partnerships, emergency departments and reshaping care for older people.

Big changes are bringing together health and social care services in Scotland.

Traditionally, the NHS has provided health services and councils have provided social care. The new reforms will see these services planned and resourced by one local organisation, intended to create a seamless system which gives people the care they need, at the right time and place.

All adult social care and some health services including GPs, community healthcare, and certain hospital services (those which are mainly unplanned, such as A&E) are covered by the reforms. This makes the potential impact of integration wide reaching, as it involves services relied on by many. And as a country, we’re getting older, which means it’s likely the number of people needing health and social care services will increase in the years to come.

We also found some evidence to suggest that local areas might not be in a position to make a huge difference in 2016/17. There are difficulties agreeing how much money councils and NHS boards will bring together to provide integrated services. This, combined with uncertainty about much funding will be available in the longer term, means some local areas don’t have clear plans for how and when services will change.

If integration is going to make a real difference to people who use health and social care services, it’s important that all local areas make detailed plans for how they’ll make the necessary changes. It’s also important to be clear how they will measure the impact of these changes.

We found other issues that need resolved if the reforms are to be successful. For example, the new system is complicated, and it’ll be important that each local area makes clear, to both staff and the public, who is responsible for the health and social care provided.

There are also issues relating to available staff in health and social care. These include considering how this workforce can best contribute to changes to the services provided and how to recruit people into jobs where there are shortages of suitably skilled staff.

Like the different bodies involved in integration, Audit Scotland recognises the importance of getting this right and the consequences if that doesn’t happen, and we’ve made detailed recommendations to support improvement in our report to the Accounts Commission and the Auditor General. We’ll begin the next audit looking at the further progress of integration in early 2017.

In the meantime, we’re discussing our findings and recommendations with members of the Scottish Parliament’s Public Audit Committee on Wednesday (13 January). You can view the agenda, and watch the meeting live, via the Parliament’s website.

About the author

Rebecca Smallwood is an auditor and joined Audit Scotland in 2008. She has worked on a number of audits with a health and social care focus, including community health partnerships, emergency departments and reshaping care for older people.